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Housing and Older Adults: Affordable Personal Care September 26 2018

Learn about the challenges of serving a low-income population and the importance of safe, quality housing in providing care for older adults. Explore different housing options and the financial considerations involved.

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Housing and Older Adults: Affordable Personal Care September 26 2018

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  1. Housing and Older Adults: Affordable Personal Care September 26 2018 South Central Pennsylvania Regional Housing Summit Debbie Loucks, Exec. Director York Area Housing Group Moderator Ann Kunkel, RN BSN Senior Director Case Management WellSpan Health Xzavier Hunter, Owner Harmony Personal Care Home Dianna Benaknin, MSW Project Consultant York Area Housing Group/WellSpan Health

  2. Regardless of Income, Adults with Care Needs Have a Right to Safe, Quality Care in the Least Restrictive, Integrated Community Setting

  3. Harmony Personal Care Home Who We Are - Who We Serve

  4. The Faces of Harmony Phil

  5. The Faces of Harmony Tim

  6. Challenges of Serving a Low Income Population • Residents with limited income • Low reimbursement for those eligible for PA Personal Care Home Supplement • Facilities in need of costly updates • Increased population with behavioral health challenges

  7. Housing as a Social Determinant of Health Health is powerfully shaped by the places and spaces where we live, work, study, and play. Health is more than a by-product of what we eat, or whether we go to the doctor. Health is influenced by a wide range of “non-health” policies – such as housing, education, transportation, land use, etc. There are significant healthcare inequities in our community, rooted in historic and contemporary forces, such as racism, discrimination, segregation, and poverty concentration. Community members too frequently face a range of barriers to health and well-being that result from our policy choices. Economic stresses are significant: Over one-third of the population reports one or more economic hardships. Dr Brian Smedley, presentation June 7 2018 , York County Health Summit

  8. So What Happens When an Individual Does Not Have Safe, Stable, Supportive Housing? They come to the hospital from the community Sometimes a really long time in a really small space Occupying beds needed for acute care And they stay…

  9. Avoidable Days at York Hospital Avoidable Days January 2015 - December 2015 In 2015, we had over 4126 avoidable days in Medical surgical beds related to community placement issues These patients remain in the hospital long past the time they could be safely discharged (600 avoidable days per month at WellSpan York Hospital - 20 patients)

  10. Three Groups of Long LOS Patient types • 40% - nursing home level of care patients in need of long term placement who have a combination of financial/payer, complex medical, and psycho-social challenges. Omega Bed Lease™program • 20% - Vulnerable patients with socio-economic issues who need medical supported care in the community and have no stable permanent housing. Arches to Wellness Recuperative Care Program at Hunter Cottage • 40% - Personal Care level patients with financial and complex care issues ALPHA Community Initiative led by York Area Housing Group

  11. What about those not in the hospital? Transferred to Personal Care Homes in other counties, away from family and friends >200 remain in nursing facilities, even when their care needs no longer require that level of care Remain at risk in community without critical supervision and support - including in subsidized senior housing (>1,000 Older Adults on waiting lists for subsidized senior housing)

  12. Many Long Term Care Options Exist, Depending on Need and Resources Independent living with community resources (Agency on Aging, private pay services, senior center) Housing designed especially for older adults that may include some supports (Broad Park Manor, Delphia House, Yorktown Apts.) Group Homes, Personal Care Homes, Assisted Living Facilities provide a higher level of support (Country Meadows, Pine Manor, Broadmore, The Brunswick) Nursing Facilities provide short term and long term care for those with more care needs (Pleasant Acres, ManorCare) Home and Community Based Waiver and Senior Life Programs are an alternative to Nursing Facilities-but do not provide 24 hour care

  13. Those in the “Gap” • Do not clinically require nursing facility level of care • Need high level of supervision • Community Long Term Care services unable to meet need for 24/7 oversight • Insufficient informal supports to bridge the gap in services for 24/7 oversight • Lack financial resources to cover costs of community or facility care

  14. Math Problem • Average entry cost for Personal Care Home • $3,600 month - $43,200 year • Five years - $216,000 York County Residents Age 65 and Older • 17.1% (11,558) live below 150% of Federal Poverty level ($1485/month) • 41.7% live alone • 33.5% have one or more disabilities

  15. Gambling on How Long the Money Will Last….2 years, 5 years??? • Individuals with sufficient resources may remain in an Assisted Living/Personal Care Home, (at a higher cost) as long as the facility can meet the care needs • Once resources are spent, if monthly income is inadequate to pay the assessed cost, Assisted Living and Personal Care Homes are not required to retain residents. (Probable Eviction) • Individuals with a nursing facility level of care may be able to transition to a nursing facility with medical assistance funding; those with a personal care home level and few resources have few options

  16. SSI Supplement beds @ $36.30/ day-no increase since 2007 Individual resources do not support cost Waiver services not approved for Assisted Living 20-30%vacancy Assisted living/ Personal Care facilities Why ALPHA? Access Issues in York County - Decline in SSI beds to 60 as of 08/01/2018 #Beds that accept the supplement as payment 70% decrease in the availability of low income Personal Care Home beds in York County over 8 years

  17. Industry Trends for Personal Care Homes in PA

  18. York County Comparison - August 2018 Disparity in Number of Affordable Personal Care Home Beds

  19. PA Personal Care Home Supplement In PA, adults with income <$1189.30/month that need supervised care and reside in a personal care home may be eligible for a state “supplement” to their SSI monthly income to help cover the cost of services. Total Amount Personal Income Federal SSI PA State Supplement $1,189.30 + = = + <$489 $? <$750 $750 Provider Payment Personal Allowance Daily Rate $36.30 + $85 $1104.30

  20. What can you buy with $36.30/day? • One day of dog boarding - (provided you bring the food and medicine)

  21. ALPHA Action Teams Community engagement to sustain existing facilities

  22. Continue the Great Work of the Community Action Teams Fortify with volunteers working directly with homes Advocate For Increase in State Supplement Rate with legislators Flexibility to include MA Waiver services in Assisted Living Facilities Partner to develop demonstration site Use our ALPHA Ambassadors

  23. Everyone deserves a safe, decent, affordable place to call home Supported by funding from Give Local York and from YCCF’s Chester H. Thomas fund.

  24. What Can Be Bought For $1,000?

  25. Why ALPHA is Important to Me

  26. “Inequities in health [and] avoidable health inequalities arise because of the circumstances in which people grow, live, work, and age, and the systems put in place to deal with illness. The conditions in which people live and die are, in turn, shaped by political, social, and economic forces.” World Health Organization Commission on the Social Determinants of Health (2008)

  27. ALPHA Next Steps Continue to engage action teams towards outcomes Expand partnerships for direct support of ALPHA Homes • Faith based, professional, civic organizations Advocacy for increase in PA Personal Care Home Supplement Advocacy for MA Waiver services in Assisted Living Establish partnerships to support demonstration project Education and advocacy at all levels Statewide mobilization

  28. Like and Follow us on Facebook. https://www.facebook.com/YorkCountyALPHAProject Educate your contacts on the barriers within long term care in our community - Most individuals only face this at a time of crisis Advocate with elected officials for an increase to the PA Personal Care Home Supplement Rate Embrace the issue of affordable Personal Care Home as part of your organization’s policy agenda Volunteer for an action committee Volunteer at a Personal Care Home Donations of goods or financial support Individual Ask Become an ALPHA Ambassador

  29. ALPHA Facebook https://www.facebook.com/YorkCountyALPHAProject

  30. For More Information: • Dianna Benaknin, MSW • Project Consultant • York Area Housing Group/WellSpan Health • dbenaknin@gmail.com • 717-779-7762

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